Medical Records Service May Charge Full Statutory Amount for Copies Even Where Lesser Charge is Reasonable
By Elizabeth F. Larsen and Jennifer L. Morris
Health care providers are often asked to comply with medical record requests from attorneys, patients, insurance companies, other providers and even governmental agencies. When medical records are requested, how much does a provider charge? The release of information can be a time-consuming and delicate function. The request must be verified to ensure its validity, a search for records must be performed, the records must be retrieved, the records must be reviewed to ensure compliance with the request, an invoice must be created, the requested information must be sent to the requestor, payments must be tracked, and records must be refiled and returned to their original location. All this must be done while ensuring compliance with HIPAA and state privacy laws.
Because of the complexities in the process of complying with requests for medical records, health care providers set their fees high – higher than would be tolerated by requestors, who felt that anything other than standard photocopying charges was unreasonable. After a flood of lawsuits regarding medical record release charges, the State and Federal government each passed legislation setting forth the fees that can be charged for release of information services.
Illinois law allows providers to charge a “reasonable fee” for the copying of records. Such “reasonable fee” may include a handling charge for processing the request, as well as the actual postage or shipping charge, if any, plus per-page copying charges. For materials or information that cannot be copied by a standard commercial photocopy machine such as x-ray films or pictures, a hospital may charge a reasonable fee based upon the cost of duplication. The maximum fee limits established by statute are adjusted annually to reflect changes in the consumer price index. The amounts established upon each annual adjustment are determined by the Comptroller and made available on the Comptroller’s website by January 31 of every year.
The fee limits as adjusted for 2010 are as follows:
- Handling charge – $24.44
- Copy pages 1 through 25 – $0.92
- Copy pages 26 through 50 – $0.61
- Copy pages in excess of 50 – $0.31
- Copies made from microfiche or microfilm – $1.53
Illinois has also been prompt in addressing the issue of electronic medical records, providing a different rate for records produced in an electronic format. Thus, when available and requested by the patient, records produced in an electronic format must be provided at 50% of the paper copy rate.
Under HIPAA, the amount charged for copies of medical records is further limited when those records are being provided to the individual patient. Thus, if records are being provided to a patient, a covered entity may charge a reasonable, cost-based fee for the copying, including the labor and supply costs of copying. These direct costs may include paper or computer disks, and postage. However, covered entities may not charge patients any fees for retrieving or handling the information or for processing the request.
The Federal HIPAA law supersedes the Illinois statute. Therefore, when health care providers provide records directly to a patient, the more stringent HIPAA restrictions apply, and no handling or processing fee may be charged. On the other hand, when providing records to attorneys, insurance companies or other entities beyond the patient, the limits imposed by the Illinois schedule may be charged.
In the recent case of Solon v. Midwest Medical Records Association, the Illinois Supreme Court addressed the question of whether it is reasonable for a provider of medical record copies to charge the full fee allowed under statute for processing requests for copies, or if the provider is limited to a lesser charge if the evidence shows that a lesser charge is all that is reasonable. Solon arose out of a class action suit against a management company that contracted with hospitals and healthcare practitioners to handle requests for patient medical records. The company did not charge health care providers for its services, but instead directly billed the party requesting the records. The suit alleged that the management company overcharged for fulfilling patient requests for medical records.
The court found that it is permissible for the management company to charge the full fee (then $20.00) as a processing fee even if a lesser amount is all that is reasonable. The court noted that a uniform fee prevents each healthcare provider from making an individual determination as to the appropriate charge for each copy request. Such a determination, the court stated, would inevitably result in a lack of uniformity and inequities among those requesting records. Accordingly, when records are requested, it can be expected that the full amount allowed as processing fee will be charged even if the number of records received is relatively small.
It is thus in the interest of requestors and health care providers alike to keep apprised of the applicable regulations regarding the release of protected health information. Verifying compliance with the current fee limits will allow health care providers to be reimbursed at the highest possible rate under the law, and save requestors from incurring excessive charges.
Originally published in the Summer 2010 edition of Quinn Quarterly.